title: Management of severe proximal vascular and neural injury of the upper extremity.
abstract: OBJECTIVE
  Early amputation has been suggested to be the optimal treatment for severe combined vascular and neural injuries of the proximal upper extremity. This retrospective study was done to evaluate the long-term clinical outcome of our policy of limb salvage by revascularization and delayed treatment of neural injuries.
  
  
  METHODS
  Forty-six patients with neural and vascular trauma to the upper extremity were treated at our institution. All of these patients had aggressive treatment directed at limb salvage with restoration of vascular supply and nerve function. Long-term vascular and neurologic outcomes were recorded. Neurologic deficits were validated by the American Medical Association's standardized disability impairment scale (0% to 100%).
  
  
  RESULTS
  The rate of preoperative disability was 83%, which improved to 52% (p < 0.01) after treatment (mean follow-up, 43 months). Overall, 87% showed improvement.
  
  
  CONCLUSIONS
  These results suggest that early amputation should not be performed unless there is massive tissue loss or an attempt at limb salvage might endanger life. Final outcomes cannot be predicted on the basis of initial clinical presentation. As a group, the majority of these patients improved with aggressive intervention.
authors.affiliation: Department of Surgery, Ochsner Clinic, New Orleans, LA 70121, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Manord
authors.forename: C L
authors.initials: CL
authors.lastname: Garrard
authors.forename: D G
authors.initials: DG
authors.lastname: Kline
authors.forename: W C
authors.initials: WC
authors.lastname: Sternbergh
authors.forename: S R
authors.initials: SR
authors.lastname: Money
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001132:Arm / Q000098:blood supply* / Q000294:innervation* / Q000601:surgery; D001134:Arm Injuries / Q000601:surgery*; D001808:Blood Vessels / Q000293:injuries; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D059348:Peripheral Nerve Injuries; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures